'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

GPs' allergic disease treatment under fire

With male GPs under fire over antidepressant prescribing, Dr Jones calls for some clear guidance

An NOP survey suggests

61 per cent of male GPs but only 37 per cent female GPs offer antidepressants as first-line strategies for mild or moderate depression.

Female GPs were praised for being more likely to favour counselling. Headlines such as 'Male depression pill bias' have been appearing.

So have I, as a male GP, taken this bravely on the chin, accompanied by feelings of shame and mortification? No. Because this is media nonsense and it's got nothing to do with how we all manage depressed patients.

This was a survey of 2,000 GPs asking what their first-line strategy would be for treating depression. Now I can't believe there is a single GP in the country that has a fixed approach to a given problem ­ a 'first-line strategy'. I'm sure most of us would want to give the patients a choice of options.

The difference in prescribing patterns exists because there is no clear guidance on what is best. So we all try to do our best as we see it. The fact of the matter is that situation is extremely confused.

Rusty stable doors

The current NICE guidelines, which are more or less binding on our terms of clinical governance, recommend antidepressants as first-line, specifically SSRIs for the treatment of moderate or severe depression. Meta-analyses now show these tablets have little or no long-term benefit against placebo.

We also know that in longitudinal studies the benefits of either medication or behavioural therapy have little long-term difference on relapse rates. We have seen huge marketing of SSRIs since their introduction in the 1970s, and

a 253 per cent increase in prescribing in this decade. It might be reasonable to suggest the stable doors are a little rusty since the horse bolted with the licensing of Prozac in the late 1980s.

It seems a bit rich to target GPs of whatever sex under these circumstances. Every recent review on depression questions anything from drug company marketing, the design of clinical trials supporting antidepressants and the role

of drug regulators, to recent meta-analyses and the planned revision of NICE guidance. In the absence of a unified consensus it is amazing to find ourselves under the spotlight.

What we need as GPs is some workable guidance that we can use both clinically and to commission future services.